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One in five MDs have prescribed placebos

The Globe and Mail

Are you getting the real deal from your doctor?

In a survey of Canadian physicians, one in five acknowledged occasionally prescribing their patients placebos, or using medications well below the active dose.

But don't feel cheated or deceived; your doctor was likely acting in your best interest. In fact, you may have benefited from the so-called placebo effect - in which some patients feel better because they believe they have been given a real therapy.

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"Sometimes just thinking that they are getting treatment is enough to elicit some kind of therapeutic response," said Amir Raz, a professor of psychiatry at McGill University in Montreal.

Placebos are routinely used for comparison purposes in clinical trials of new and experimental drugs. But in recent years, researchers have learned that dummy pills - and essentially the power of suggestion - can influence patients' perceptions and sometimes their physical condition.

The idea of using what amounts to sugar pills on regular patients, without their prior consent, however, is highly controversial. "When you mention placebos, some people automatically assume that it involves lying, deception and some kind of shenanigans," said Dr. Raz.

To gauge the use of placebos in daily medicine, Dr. Raz and his research colleagues e-mailed questionnaires to physicians who hold positions at academic institutions across Canada.

Promised absolute confidentiality in their answers, about 600 doctors responded. Of those physicians, 20 per cent reported using placebos or pseudo-placebos in various forms. For instance, doctors may prescribe a real medication, but at such a low dose that it is chemically inactive. Or, they may recommend a therapy that is unlikely to affect the condition, such as using vitamins to treat chronic insomnia. Yet many patients report an improvement, even though "there is no pharmacological reason for them to feel better."

Dr. Raz said many experienced physicians come to appreciate the fact that "sometimes just the act of providing attention, some comfort and simply listening to the patient can actually have a profound effect on some clinical symptoms."

But a lot of doctors don't have much time to spend with patients. So some of them appear to have become "quite savvy at using placebos," said Dr. Raz.

Placebos have been shown to be "extremely potent" in many fields of medicine, including psychiatry, rheumatology, immunology, pediatrics and even some surgeries, he said.

"I think most doctors are well-meaning and try to cater to their patients," he said. Nonetheless, there is still a great deal of misunderstanding about placebos. And most doctors don't get formal training. Dr. Raz noted that he teaches the only course on the science of placebos offered at a Canadian medical school.

The survey, published in the Canadian Journal of Psychiatry, demonstrates that the use of placebos is widespread. "It's quite clear it is happening," said Dr. Raz. "We better deal with it directly as opposed to sticking our heads in the sand."

He believes placebos could be used ethically, provided the right guidelines are in place. In Germany, for instance, the medical body that regulates doctors recently amended the professional code of conduct to allow placebos under certain circumstances. The Canadian Medical Association currently has no such formal policy.

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